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1.
Sultan Qaboos Univ Med J ; 21(2): e297-e301, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34221479

RESUMO

Objectives: Bone failure due to avascular necrosis (AVN) is a complex pathological phenomenon. Analysis of molecular changes in the bone matrix may help to shed light on the disease process and guide management. This study aimed to explore changes in bone quality and structural damage caused by sickle cell disease (SCD)-induced AVN using Raman spectroscopy. Methods: A total of 10 necrotic femoral heads were obtained from seven SCD patients who underwent total hip replacements. The femoral heads were cut in half and scanned using Raman spectroscopy in correlation with preoperative magnetic resonance imaging to identify necrotic and healthy control areas. Subsequently, samples were examined to determine changes in bone mineralisation, crystallinity, carbonate content, collagen cross-linking and mineral and collagen fibril orientation. Results: Significant changes were observed in bone mineral content, mineral-to-organic content and collagen fibril orientation in necrotic compared to control areas (P ≤0.050). Conclusion: The necrotic samples displayed severe structural damage and loss of mineral and organic contents. Similar Raman signals have been reported in other metabolic bone diseases such as osteoporosis, thereby potentially supporting the use of medical treatment in AVN to promote bone quality.


Assuntos
Anemia Falciforme/complicações , Necrose da Cabeça do Fêmur/patologia , Análise Espectral Raman/métodos , Anemia Falciforme/terapia , Densidade Óssea , Remodelação Óssea , Calcificação Fisiológica , Matriz Extracelular , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Necrose/induzido quimicamente , Necrose/patologia , Necrose/cirurgia
2.
J Trauma Acute Care Surg ; 91(1): 241-246, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144567

RESUMO

BACKGROUND: During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS: A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS: A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION: Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
COVID-19/prevenção & controle , Emergências/epidemiologia , Mortalidade Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Doença Aguda/mortalidade , Doença Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/mortalidade , Apendicite/cirurgia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Colecistite/diagnóstico , Colecistite/mortalidade , Colecistite/cirurgia , Serviço Hospitalar de Emergência , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/mortalidade , Hérnia Inguinal/cirurgia , Hérnia Ventral/diagnóstico , Hérnia Ventral/mortalidade , Hérnia Ventral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , New York/epidemiologia , Pandemias/prevenção & controle , Admissão do Paciente/tendências , Úlcera Péptica/diagnóstico , Úlcera Péptica/mortalidade , Úlcera Péptica/cirurgia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências , Adulto Jovem
3.
Microsurgery ; 41(7): 671-675, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34156111

RESUMO

The medial tarsal area is a commonly used donor site for skin grafts to the digits and toes, with good color and texture match as well as a concealable donor site scar. Yet, there has been no report as a perforator free flap donor site. The purpose of this report is to present a new perforator flap harvested from medial tarsal region. We present a case of a soft tissue defect of the fifth toe due to essential thrombocythemia (ET), successfully treated with a free medialis tarsus flap (MTF) transfer. A 62-year-old male with ET suffered from the right fifth toe necrosis caused by digital artery thrombosis. After the manifestation of the necrosis, necrotic tissue was completely debrided, which resulted in a 3 × 1.5 cm skin defect with exposure of the tendon and the phalangeal bone. Sixth days after debridement, a 4.5 × 1.7 cm MTF was harvested transversely and inferiorly to the right medial ankle, locating the preoperatively detected posterior tibial artery perforator (PTAP) in the flap. Perforator-to-perforator anastomosis was done using the dorsal metatarsal artery perforator and the subcutaneous vein as recipient vessels. The donor site was closed primarily. Postoperative course was uneventful, and the reconstruction preserved the toe length and functions of extension and flexion at 9 months postoperatively. The patient could walk with conventional shoes by himself. MTF may be an option for small skin defect in the digits and toes where skin graft is not indicated.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Tornozelo , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/cirurgia
4.
Isr Med Assoc J ; 23(6): 373-375, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34155851

RESUMO

BACKGROUND: Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented.


Assuntos
Abdominoplastia , Tecido Adiposo/imunologia , Obesidade Abdominal/cirurgia , Escleroderma Sistêmico , Pele/patologia , Deiscência da Ferida Operatória , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Anticorpos Antinucleares/sangue , Cicatriz/diagnóstico , Cicatriz/etiologia , Contraindicações de Procedimentos , Feminino , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/imunologia , Necrose/cirurgia , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Reoperação/efeitos adversos , Reoperação/métodos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Escleroderma Sistêmico/cirurgia , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Resultado do Tratamento
5.
Adv Skin Wound Care ; 34(7): 1-6, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34125732

RESUMO

ABSTRACT: Purpura fulminans can result in significant full-thickness wounds, posing a challenge in the pediatric population, given the paucity of donor sites for reconstruction. The authors present the case of an 11-month-old patient for whom a split-thickness skin allograft (TheraSkin) was successfully implemented as a temporizing measure for a large leg wound.


Assuntos
Extremidade Inferior/fisiopatologia , Necrose/cirurgia , Púrpura Fulminante/complicações , Procedimentos Cirúrgicos Reconstrutivos/métodos , Criança , Feminino , Humanos , Necrose/etiologia , Pediatria/métodos , Púrpura Fulminante/fisiopatologia , Púrpura Fulminante/cirurgia , Transplante de Pele/métodos , Texas , Cicatrização/fisiologia
6.
Medicine (Baltimore) ; 100(20): e25659, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011027

RESUMO

ABSTRACT: Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.


Assuntos
Amputação/estatística & dados numéricos , Dedos/irrigação sanguínea , Isquemia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/complicações , Embolia/epidemiologia , Feminino , Dedos/patologia , Dedos/cirurgia , Seguimentos , Humanos , Doença Iatrogênica/epidemiologia , Isquemia/epidemiologia , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Pessoa de Meia-Idade , Necrose/epidemiologia , Necrose/etiologia , Necrose/cirurgia , Neoplasias/complicações , Neoplasias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Taxa de Sobrevida , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/epidemiologia , Trombose/complicações , Trombose/epidemiologia , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia
7.
J Surg Res ; 264: 296-308, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33845413

RESUMO

BACKGROUND: Skin-sparing debridement (SSd) was introduced as an alternative to en bloc debridement (EBd) to decrease morbidity caused by scars in patients surviving Necrotizing soft-tissue infections (NSTI). An overview of potential advantages and disadvantages is needed. The aim of this review was to assess (1) whether SSd is noninferior to EBd regarding general outcomes, that is, mortality, length of stay (LOS), complications, and (2) if SSd does indeed result in decreased skin defects. METHODS: A systematic literature search was performed according to the PRISMA guidelines. All human studies describing patients treated with SSd were included, when at least of evidence level consecutive case series. Studies describing up to 20 patients were pooled to improve readability and prevent overemphasis of findings from single small studies. RESULTS: Ten studies, one cohort study and nine case series, all classified as poor based on Chambers criteria for case series, were included. Compared to patients treated with EBd, patients treated with SSd had no increased mortality rate, LOS or complication rate. SSd-treated patients had a high rate (75%) of total delayed primary closure (DPC) in the pooled case series. CONCLUSION: The current available evidence is of insufficient quality to conclude whether SSd is noninferior to EBd for all assessed outcomes. There are suggestions that SSd may result in a decreased need for skin transplants, which could potentially improve the (health related) quality of life in survivors. Experienced surgical teams could cautiously implement SSd under close monitoring, ideally with uniform outcome registry.


Assuntos
Desbridamento/métodos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/epidemiologia , Infecções dos Tecidos Moles/cirurgia , Tela Subcutânea/patologia , Desbridamento/efeitos adversos , Humanos , Tempo de Internação/estatística & dados numéricos , Necrose/cirurgia , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Pele/patologia , Transplante de Pele/estatística & dados numéricos , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/patologia , Tela Subcutânea/cirurgia , Resultado do Tratamento
9.
Wounds ; 33(4): 99-105, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33872203

RESUMO

INTRODUCTION: The COVID-19 virus is caused by the new coronavirus, SARS-CoV-2. COVID-19 has drastically changed the medical landscape. Although predominantly impacting the respiratory system, COVID-19 has several non-respiratory symptoms associated with its presentation and course. Among these are gastrointestinal symptoms and thromboembolic events with stroke. Increasingly recognized, but often overlooked, are the coagulopathy phenomena occurring with COVID-19. The severe respiratory symptoms are the primary focus of clinical management. However, close inspection of patients demonstrates that patients often exhibit both thromboembolic and bleeding events, ranging from simple skin lesions to overt emergencies. CASE REPORT: The author presents a case of COVID-19-associated coagulopathy resulting in compartment syndrome of the arm with volar forearm necrosis, requiring flap reconstruction and tendon transfer to salvage the upper extremity. CONCLUSIONS: Massive rhabdomyolysis resulted in acute tubular necrosis with renal failure requiring hemodialysis. The timing of reconstruction of the sequelae of compartment syndrome in an acutely ill patient is challenging, but optimal timing can result in a successful outcome.


Assuntos
COVID-19/complicações , Síndromes Compartimentais/cirurgia , Pandemias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , COVID-19/epidemiologia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Antebraço , Humanos , Masculino , Necrose/diagnóstico , Necrose/etiologia , Necrose/cirurgia , SARS-CoV-2
10.
Khirurgiia (Mosk) ; (3): 20-25, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33710822

RESUMO

OBJECTIVE: To report initial experience of endoscopic transluminal drainage of infected pancreatic necrosis. MATERIAL AND METHODS: There were 8 patients with acute severe pancreatitis and large-focal pancreatic necrosis who underwent transluminal drainage of destruction zones for the period from December 2018 to October 2019. RESULTS: Transluminal drainage of pancreatogenic destruction zones in acute severe pancreatitis can be considered as the only surgical approach in 50% of cases that is comparable with literature data.


Assuntos
Endoscopia , Pancreatite Necrosante Aguda , Drenagem , Endoscopia/métodos , Humanos , Necrose/etiologia , Necrose/cirurgia , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Resultado do Tratamento
11.
Dermatol Surg ; 47(2): 245-249, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565777

RESUMO

BACKGROUND: Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage. PATIENTS AND METHODS: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019. RESULTS: Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001). CONCLUSION: The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control. LEVELS OF EVIDENCE: II.


Assuntos
Anestesia Local , Curetagem/instrumentação , Epinefrina , Hiperidrose/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Vasoconstritores , Anestésicos Locais , Axila/cirurgia , Curetagem/efeitos adversos , Desbridamento , Feminino , Hematoma/etiologia , Humanos , Lidocaína , Masculino , Necrose/etiologia , Necrose/cirurgia , Odorantes , Dor Pós-Operatória/etiologia , Reoperação , Estudos Retrospectivos , Seroma/etiologia , Pele/patologia , Sucção/instrumentação , Infecção da Ferida Cirúrgica/cirurgia
13.
BMJ Case Rep ; 14(2)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33637492

RESUMO

A 10-year-old boy was referred by urologist to plastic surgery department with penile shaft necrosis after debridement of necrotic tissue and dry eschar that extends from the glans to the penile root and was started to separate. Also, they managed to insert urethral catheter. He had traditional circumcision 2 weeks earlier performed at home by a traditional health practitioner, resulting in full-thickness tissue loss involving skin and corpora cavernosa with sparing of the glans which was attached by stalk of scared tissue enveloping the spongiosum. After assessment and analysis of the defect was done, two-stage pedicled groin flap reconstruction was performed with satisfactory results. In this report, we are demonstrating procedure steps and outcome.


Assuntos
Circuncisão Masculina , Procedimentos Cirúrgicos Reconstrutivos , Criança , Circuncisão Masculina/efeitos adversos , Virilha/cirurgia , Humanos , Masculino , Necrose/etiologia , Necrose/cirurgia , Pênis/cirurgia , Retalhos Cirúrgicos
14.
AJR Am J Roentgenol ; 217(4): 921-932, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33470838

RESUMO

Management of acute pancreatitis is challenging in the presence of local complications that include pancreatic and peripancreatic collections and vascular complications. This review, targeted for interventional radiologists, describes minimally invasive endoscopic, image-guided percutaneous, and surgical procedures for management of complicated pancreatitis and provides insight into the procedures' algorithmic application. Local complications are optimally managed in a multidisciplinary team setting that includes advanced endoscopists; pancreatic surgeons; diagnostic and interventional radiologists; and specialists in infectious disease, nutrition, and critical care medicine. Large symptomatic or complicated sterile collections and secondary infected collections warrant drainage or débridement. The drainage is usually delayed for 4-6 weeks unless clinical deterioration warrants early intervention. If collections are accessible by endoscopy, endoscopic procedures are preferred to avoid pancreaticocutaneous fistulas. Image-guided percutaneous drainage is indicated for symptomatic collections that are not accessible for endoscopic drainage or that present in the acute setting before developing a mature wall. Peripancreatic arterial pseudoaneurysms should be embolized before necrosectomy procedures to prevent potentially life-threatening hemorrhage. Surgical procedures are reserved for symptomatic collections that persist despite endoscopic or interventional drainage attempts. Understanding these procedures facilitates their integration by interventional radiologists into the complex longitudinal care of patients with complicated pancreatitis.


Assuntos
Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Radiografia Intervencionista , Doença Aguda , Algoritmos , Biópsia por Agulha Fina , Desbridamento , Drenagem , Endoscopia do Sistema Digestório/métodos , Humanos , Necrose/cirurgia , Pancreatite/complicações , Pancreatite/patologia , Equipe de Assistência ao Paciente , Stents , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia
15.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408103

RESUMO

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Assuntos
Dor Abdominal/etiologia , Colecistectomia Laparoscópica , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Anormalidade Torcional/diagnóstico , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Necrose/diagnóstico , Necrose/cirurgia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Ultrassonografia
18.
Int J Surg Pathol ; 29(2): 120-128, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32484057

RESUMO

Chondroblastoma is a rare benign tumor of immature cartilage cells that generally occurs in an epiphyseal location of skeletally immature individuals. However, a few studies have reported cases in older patients. The purpose of this study was to evaluate the clinical, radiographic, and pathologic features of chondroblastoma in an adult population. The pathology archives of our institution were searched for cases of chondroblastoma diagnosed in patients ≥25 years of age. Of 14 patients identified, 8 were male and 6 were female with a median age of 34 years (range = 29-54 years). Most lesions occurred in short bones of hands and feet (N = 7, 50%), followed by the long tubular bones (N = 4, 28%). All demonstrated typical histologic features of chondroblastoma, but more extensive calcification, necrosis, and degenerative changes were also seen. At follow-up (median = 73.5 months), 2 patients (17%) had local recurrence. None had metastasis. In summary, chondroblastoma in adults tends to involve the short bones of the hands and feet and demonstrate histologic changes associated with long-standing growth of a benign tumor.


Assuntos
Neoplasias Ósseas/cirurgia , Osso e Ossos/patologia , Condroblastoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/cirurgia , Condroblastoma/diagnóstico , Condroblastoma/patologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/patologia , Necrose/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Ann Thorac Surg ; 111(1): 52-60, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32569666

RESUMO

BACKGROUND: Patients with acute type A aortic dissection with a previous cardiac surgery (PCS) and malperfusion syndrome (MPS) are extremely difficult to manage and have poor outcomes. METHODS: From 1996 to 2018, 668 patients underwent emergent open aortic repair or endovascular fenestration/stenting for MPS for an acute type A aortic dissection, including those with PCS (PCS, n = 64) and those without PCS (No-PCS, n = 604). The groups were further divided into PCS+MPS, PCS+No-MPS, No-PCS+MPS, and No-PCS+No-MPS. RESULTS: Compared with the No-PCS group, the PCS group had significantly more coronary artery disease, acute renal failure, and mesenteric and renal MPS. Forty-two percent of patients with PCS underwent upfront endovascular fenestration/stenting for endovascular-amendable MPS. The in-hospital mortality was significantly higher in patients with PCS+MPS (40%) compared with PCS+No-MPS (5.9%), No-PCS+MPS (30%), and No-PCS+No-MPS (6.7%). Multivariable logistic regression showed cardiogenic shock (odds ratio, 7.3) and MPS (odds ratio, 6.6) were risk factors for in-hospital mortality (P < .001). After recovering from MPS the PCS group (n = 54) had similar rates of postoperative complications, including 30-day mortality (7.4% vs 6.3%, P = .77), compared with the No-PCS group (n = 557). The 5-year survival was significantly lower in the PCS group compared with the No-PCS group (60% vs 72%, P = .004) and was lowest in those with PCS+MPS (46%). PCS was not a significant risk factor for in-hospital (odds ratio, 1.2; P = .63) or late (hazard ratio, 1.3; P = .27) mortality. CONCLUSIONS: Because of severe preoperative comorbidities and the complexity of open aortic repair, in acute type A aortic dissection patients with PCS and MPS, endovascular fenestration and stenting first with delayed redo sternotomy and central aortic repair was a valid approach.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Procedimentos Cirúrgicos Cardíacos , Isquemia/complicações , Isquemia/cirurgia , Complicações Pós-Operatórias/cirurgia , Doença Aguda , Idoso , Aneurisma Dissecante/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/complicações , Necrose/cirurgia , Estudos Retrospectivos , Síndrome
20.
Int J Surg Pathol ; 29(2): 205-210, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32552130

RESUMO

In this article, we report a very rare case of secondary angiosarcoma in a young woman with no prior history of breast cancer who had bilateral prophylactic mastectomies with autologous reconstruction due to a strong family history of breast cancer and BRCA1 gene variant of uncertain significance. The surgery was complicated by recurrent fat necrosis requiring several excisions and additional reconstruction followed by the development of localized lymphedema and subsequent angiosarcoma in the reconstructed breast 10 years later. The angiosarcoma was high grade with prominent epithelioid features associated with abundant tumor-infiltrating lymphocytes. Amplification of C-MYC locus 8q21.24 was demonstrated by fluorescence in situ hybridization study. We postulate that chronic trauma from several surgeries including tissue hypoxia and impaired lymphatic drainage may have provided a milieu for angiogenesis and mutagenic transformation. Amplification of C-MYC locus 8q21.24 was most likely a strong oncogenic driver of angiosarcoma. To the best of our knowledge, this is the first report of its kind in the literature.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Hemangiossarcoma/diagnóstico , Complicações Pós-Operatórias/cirurgia , Proteínas Proto-Oncogênicas c-myc/genética , Tecido Adiposo/patologia , Proteína BRCA1/genética , Mama/cirurgia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Amplificação de Genes , Hemangiossarcoma/genética , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Linfócitos do Interstício Tumoral , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Necrose/diagnóstico , Necrose/etiologia , Necrose/patologia , Necrose/cirurgia , Retalho Perfurante/efeitos adversos , Retalho Perfurante/transplante , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Mastectomia Profilática/efeitos adversos , Reto do Abdome/transplante , Recidiva , Adulto Jovem
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